A patient I've treated for many, many years. Suffers from mild Atrial Fibrillation. Makes him feel tired. Takes digoxin and coumadin. Has mild COPD, makes him tired, hasn't smoked in years. Former lobster man. Getting progressive senile dementia. Wife may not be "tracking" so well, either. They called in today asking for a refill on generic coumadin 5 mg tablets. They secretary okayed the refill, called the pharmacy and orderd Aricept 5 mg tablets. Aricept appears at the top his printed med list. The error was not discovered until the patient and his wife got home. They called the pharmacy and were told that medicines could not be returned. Unponed bottle, reliable patients. The secretary called and explained it was her mistake. The pharmacy agreed and said they would not reimburse the patient 150 dollars for the wrong script.
I spoke to the pharmacy manager. She was insistent that it was not "fair" that 150 dollars should come from their "bottom line". I asked if she thought the answer was for my secretary to pay the patients 150 dollars from her salary and should I fire the secretary? She simply said it was not her fault and gave me the 800 number for "corparate headquarters".
Questions: Do we fire the secretary? Do we reimburse the patient? How to we improve patient call-in refill requests?
7 comments:
What on earth is the secretary doing phoning in a prescription of any kind, even a refill? That doesn't sound legal to me.
Yes you should reimburse the patient if you can't persuade the pharmacy to take back the medication which is unlikely since it is illegal for them to take back medication which has left the pharmacy, and since the error was made by your office.
No you shouldn't fire the secretary, because you were allowing her to do something she was not qualified to do. You should revise your refill authorization procedure so that it occurs between two qualified professionals one at each end.
Why was the patient asking for a refill at the office instead of at the pharmacy? If there were no authorized repeats, or they were all used up, on the original prescription the pharmacist would then phone the doctor's office for authorization from the doctor to refill the prescription. You could follow it up with a fax.
Do the right thing and revise your procedures so this never happens again. A secretary is a secretary not a medical professional, no matter how capable in other areas.
regards
jmb
Legally the pharmacy can not take the drug back and the mistake was made by a non-qualified individual that works for you. So, in my opinion, you should 1) apologize to the patient, 2)reimburse the $150, 3)be thankful the patient discovered the mistake, 4)not fire the secretary, 5)have a nurse handle the refills, 6)counsel patients on asking for refills at the pharmacy, not at the office.
Wow! That's a really gnarly one, Dr. Jim. I tend to agree that it was the secretary's fault. I always hate it when I hear a non-medical person tell me "I don't have to bother Dr. ... with this, I'll send in the orders myself." The last time that happened, my regular standing order lab work went from an almost complete renal work up down to simple HTC and HGB.
I recently had to argue with another lady over the phone to even get her to ask my physician for a refill of an HTN med. She was certain I was seeker, and that clonidine was for depression! (?!)
To all physicians anywhere, I would say: please be aware of what your staff is doing, and of how much information which is meant for you, never reaches you.
Of the literally dozens of places I've been in the last 3 1/2 years, there's only been one office where the staff and physician actually seemed to be one, well organized, reliable "machine."
Sorry I've gone on and on. I simply wanted to welcome you to the blogosphere! I've blogrolled you, and am looking forward to perusing your posts.
Dr. Jim,
Ouch. I tend to agree with the previous posters, I think the office (ie you if you're a solo) needs to suck up the $150.
I've enjoyed your blog, you introduce a number of tough ethical issues.
Dr. Smak
here is my two cents. i am not a medical person, but a person that receives medical care. what would have happened if the patient took the medicine? that would have been your problem and luckily it did not happen. pay the 150 and say a prayer of thanks!
smiles, bee
Thanks for all the replies. We did review refill procedures.
Dr. Jim
My doctor i see every few months has put me on adderall, and i've been on it for about 2 years. I am in highschool in my freshman year.
So basically, The secretary called in the WRONG medication.. Called prozac, an Anti-depressent.. And i have only ADHD. I had been on this anti depressent for about 4 months, when i went back to the doctor.. He had chewed my mom out because he thought she had told the pharmacy the wrong medication.. and threatned to put her in jail, He had his secretary called the pharmacy and they checked there records.. And infact the secretary had called in PROZAC. Then he tried to calm my mom down give her icecream you know. blah blah blah, I feel this could be taken into court? I'm only a kid, but i have a future and i dont want it to be "effed" up because of some secretary. Please Dr. Jim, Give your opinion.
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